Impact of the Enhanced Recovery After Surgery (ERAS) Protocol on 3-Year Survival and Outcomes Following Esophagectomy: A Retrospective Cohort Study of 132 Patients

Abstract

Abstract Introduction The benefits of the Enhanced Recovery After Surgery (ERAS) protocol are well-documented across surgeries, but its impact on esophageal cancer surgery remains understudied. This study compares 3-year survival rates in esophagectomy patients treated with and without ERAS at a tertiary care hospital. Methods A retrospective analysis of 132 esophagectomy patients (Jan 2017- Jan 2022) was conducted. Patients treated before 2019 (n = 66) received standard care, while those from 2019 onwards (n = 66) followed the ERAS protocol. Survival associations were determined using the Kaplan–Meier method and log-rank tests. Multivariate analysis identified potential survival prognostic factors. The primary outcome was 3-year overall survival and secondary outcomes were postoperative intensive care unit (ICU) stay, hospital length of stay (LOS), and complications. Results ERAS patients had significantly shorter ICU stay (mean difference: -2.3 days, p < 0.001), reduced hospital LOS (mean difference: -4.9 days, p < 0.001) and fewer postoperative pulmonary complications (0% vs. 13.6%, p = 0.002). The 3-year survival rate was higher in the ERAS group (70.16% vs. 45.29%, p = 0.028). Advanced tumor stage (III-IV) was a significant negative prognostic factor (hazard ratio = 3.08, 95% CI: 1.43–6.67, p = 0.004). Subgroup analysis showed survival benefits were most pronounced in patients with preoperative albumin < 4 g/dl, early-stage tumors (I-II), and aged < 65. Conclusions ERAS protocol implementation in esophagectomy was associated with enhanced 3-year overall survival, particularly in patients with low albumin levels, early clinical stages, and aged < 65 years. These findings underscore the potential for ERAS protocols to revolutionize esophageal cancer treatment, leading to improved patient outcomes and more efficient healthcare delivery.